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Re: Entrance Fees: Continuing Care Community
Old 09-03-2006, 06:15 PM   #21
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Re: Entrance Fees: Continuing Care Community

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Originally Posted by 2B

I hate to tell you this; but when he's in "the big one," you and your DW will also be liable. Every platiff's attorney will look at who "should have known" that someone in an assisted living facility was legally blind and deaf. That's you. Enjoy!
2B,

Unless you are a lawyer, I would have to question your statement. I would think that FIL's eye doctor would have more legal responsibility than we do. Is he required to notify DMV? Are we? Any lawyers on the board willing to offer an opinion?

Grumpy
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Re: Entrance Fees: Continuing Care Community
Old 09-03-2006, 06:25 PM   #22
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Re: Entrance Fees: Continuing Care Community

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Originally Posted by grumpy
2B,

Unless you are a lawyer, I would have to question your statement.* I would think that FIL's eye doctor would have more legal responsibility than we do.* Is he required to notify DMV?* Are we?* Any lawyers on the board willing to offer an opinion?

* Grumpy
You be screwed dear Grumpy. We heard that from my FIL's insurance company when DW called them about his new address and her POA. He has all of his insurance with the same company.

At this point, I'd just as soon shoot him than let him drive a vehicle. He has been a hazard for at least 3 years. I had told my wife and children to not ride with him under any circumstances back in 2003. He almost killed us both and didn't even see it. He would also approach stopped cars at 50 miles and hour, slam on the brakes and stop a few inches from a car. His car, which we need to get rid of, has a neat row of dings and dents around the entire vehicle.

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Re: Entrance Fees: Continuing Care Community
Old 09-03-2006, 06:31 PM   #23
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Re: Entrance Fees: Continuing Care Community

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Originally Posted by REWahoo!
"A new study raises questions about when older surgeons should quit the operating room and how they can stay at the top of their game in the final years of their careers. With the percentage of working doctors older than 65 climbing, the questions hold growing importance for patients."

"...The United States requires airline pilots to step down at age 60, but there is no mandatory retirement age for surgeons, who — like pilots — hold life in their hands."
How ironic-- the pilots have been trying to get their mandatory retirement age raised for decades.

I'm of two minds about doctors and experience. *I think gray hair is great for a little humility & perseverance, especially for avoiding "I'm the doctor, I'm in charge" personalities. *However they may also suffer from locked-in thinking or even be phoning in their performances. *Many younger doctors have been trained to know that they don't know what they don't know and are perhaps a little more willing to do the testing & research.

I guess the time I want an older doctor is when I don't want any of that "Normal for a geezer of your age" crap. *Is there a time when manual dexterity is better than experience & judgement? *Because I think that otherwise I can work better with someone who's younger.

As for pilots, when was the last time that flying an airplane required speed, reflexes, & physical dexterity? *Usually those skills just convince someone that they have the talents to get them out of situations that their bad decisions got them into. *Gimme age & conservative judgment every time.

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He ruled the roost with an iron hand and she can't move past it.
That reminds me of "Elder Rage", a most excellent book for this situation...
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Re: Entrance Fees: Continuing Care Community
Old 09-16-2006, 06:04 PM   #24
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Re: Entrance Fees: Continuing Care Community

After looking over Continuing Care Retirement Communities in our ‘neighborhood’ we found one that looked just like what we wanted, so paid a visit.* It is building a new structure to be completed in 18 months (DH observed that 2 years is more likely).* It is really nice (architect is a group DH has worked with), with an entry fee in line with its construction cost.* When we penciled the new building out it used a big hunk of our home equity and by the time the monthly charges were added we didn’t have quite as much play money as we would like.* The real capper for my husband was that they charged an additional fee for parking.* I can understand why they would do that, it provides an incentive for us seniors to get rid of the car, but that was just one nick too much in the play money budget.*

We were really impressed with the community and there were familiar faces.* Now the ‘old building’, which DH said he wasn’t thrilled about before our visit, is prime real estate because the entry fee is much less and the monthly rate somewhat less.* The wait list for a suitable apartment in the ‘old building’ is probably 4 years long, which works for us.

Observation: drill down on the details so that you know what the monthly charge does and does not include; model your cash flow using 4% annual increases in monthly expenses (energy and labor costs, also Medicare will increase higher than SS/CSRS); retirees nearing 70 who want to consider these communities should start looking now.
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 10:31 AM   #25
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Re: Entrance Fees: Continuing Care Community

OK, here's the physician's POV on "driving retirement".

First, check out two very recent links of posssible interest.

http://www.cbc.ca/cp/health/060911/x091114.html

http://www.cmaj.ca/ (see September 12, 2006 edition for links to the research paper, commentary and analysis)

The physician's legal duty to report a patient's inability to drive is often enshrined in provincial or state law. Of course, there must be evidence.

Quote from Analysis (David M. Butcher):
"The role of physicians in ensuring road safety through the identification of patients with medical conditions that make it unsafe for them to drive is an important one. It is recognized in all jurisdictions with legislation that outlines the duty to report medically unfit drivers. In most provinces and territories, this duty to report is mandatory. If driver fitness is determined to be a causative factor in a motor vehicle crash, it can be alleged that the accident would not have occurred had the driver's doctor made an appropriate report — and physicians have been found liable for damages in these circumstances."

Obviously I can't speak for the US or other countries, so check out the legislation in your jurisdiction!

Now, Grumpy's FIL clearly has visual, auditory and motor impairments that would be obvious to an examining physician. Grumpy, I suggest you first check the legal situation in your state and then march FIL off to his MD toute de suite. Let the MD know of your concerns.

The problem is (as discussed in the study) that clinical examination often does not pick up milder cognitive deficits that can impair safe driving. And if there is no provision in law for the physician to order a road test, it's "he said, she said".

When physical examination is normal, when the "evidence" of impaired driving is hearsay, and when the patient is in denial, uncertainty exists. In this situation, the physician is in an ethical conflict between the public good and his/her patient's right to confidentiality. And then we are back to moral suasion.

My DF voluntarily stopped driving when he realized his own limitations after almost running over a child that he simply didn't see. Other than slow perceptual and reaction times, he had all his marbles. Mom was furious at the loss of independence.

Meadbh
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 10:40 AM   #26
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Re: Entrance Fees: Continuing Care Community

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Originally Posted by Meadbh
Mom was furious at the loss of independence.
Mom (control freak that she was) also refused point blank to draw up a POA. Had she become incapacitated and required long-term care, this would have left me, as the only DD, liable for all her ongoing expenses, while her assets would have remained untouchable. Luckily, this did not happen.

Please don't ever put your kids in this position! It's irresponsible and selfish.

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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 11:31 AM   #27
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Re: Entrance Fees: Continuing Care Community

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Originally Posted by Meadbh
Had she become incapacitated and required long-term care, this would have left me, as the only DD, liable for all her ongoing expenses, while her assets would have remained untouchable.
I don't think that is correct. Had Mom become totally incapacitated, you might have voluntarily paid for Mom's expenses while executing a court order to achieve POA, but I don't believe you would have been legally liable to do so.
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 11:50 AM   #28
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Re: Entrance Fees: Continuing Care Community

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Originally Posted by Meadbh
Mom (control freak that she was) also refused point blank to draw up a POA. Please don't ever put your kids in this position! It's irresponsible and selfish.
Since DW and I are at an age (late 50's) where this topic is becoming very relevent, this is really an interesting thread!

We want to ensure that the kids don't have any headaches over our long term care, if LTC is necessary, but want to be as independent as safely possible for as long as possible.* We want to lock in decisions now, so they don't have to make choices for us in the future.* We've been very generous to them financially already and plan to continue to do so while we're alive.* But, we have no interest in conserving money for them in our final years that could be used to make us more independent or comfortable.* Trust isn't an issue......they've always been hard working, loyal kids of tremendous integrity.* Yet, I'd hate to see them in a position of having to decide whether to use our money to pay to upgrade us to the best, most appropriate care available or to use the money to send one of the grandkids to Harvard.* There should be no choice, spend it on us!* *

Locking that concept in legally while still leaving them some control and not hurting their feelings is turning out to be more difficult that we planned.......

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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 11:57 AM   #29
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Re: Entrance Fees: Continuing Care Community

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Originally Posted by youbet
I don't think that is correct.* Had Mom become totally incapacitated, you might have voluntarily paid for Mom's expenses while executing a court order to achieve POA, but I don't believe you would have been legally liable to do so.
Not legally, but morally liable. Had I declined to fund her care, the bank would have taken possession of her property, which would probably have generated significant legal expenses and depleted the estate, something she would not have wanted but refused to countenance. As we lived in different countries (not including the US) I am not sure how the Public Trustee / Ward of Court legalities would have been resolved. Luckily, as I said, we didn't get to that point. *
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 12:11 PM   #30
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Re: Entrance Fees: Continuing Care Community

My mother gave my older brother POA for health care--he'd be the quickest to pull the plug, and she likes that idea. She gave regular POA to my younger brother--as the only unmarried child and with no children himself, and the only child still working, she feels he will make decisions that are less influenced by others. He will be responsible for deciding how much to spend on any needed care, although she wants and expects to stay at home while receiving it. As a business owner, she feels he would make the most logical decisons--also because he, too, hates the idea of assisted living or nursing homes. As the one deemed most able to balance everyone's needs and desires, it will be my job to disburse/sell the property. Except for the house itslef, which goes equally to younger brother and me, as we're the ones who live nearby and will be caring for her as needs arise.

As for DH and me, we agree with youbet that our savings are first for our own care & comfort in old age, and only secondarily for the kids/future grandkids. We currently plan to move to a CCC community in our 70s, using our home equity to pay for it.
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 12:56 PM   #31
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Re: Entrance Fees: Continuing Care Community

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.... although she wants and expects to stay at home while receiving it. As a business owner, she feels he would make the most logical decisons--also because he, too, hates the idea of assisted living or nursing homes. ...
I really think the family should regard this as a goal, not a requirement.* Because my brother and I tried that with our mother let me tell you what is involved:* First you need to find care givers who have appropriate skills and will not take advantage of her (some have been known to induce frail elderly to change their estate planning), then you will need to schedule the caregivers who sometimes have family emergencies of their own.* I often 'slept' on* Mother's couch to be available to assist her to safely toilet in the middle of the night.* Her primary care-giver worked days 8-5, M-F.* Finding someone to work weekends wasn't easy.* It wasn't long before we were both exausted and faced the reality that it wouldn't work long term.*

Be sure to have a back-up plan once your mother starts to need home care.*
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 02:56 PM   #32
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Re: Entrance Fees: Continuing Care Community

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I really think the family should regard this as a goal, not a requirement.*
I will second Brat's comment. My FIL wanted to use home care for my MIL when she broke her hip. Their two daughters at first thought this was wonderful but my MIL needed round the clock nursing care and regular doctor visits. She could only be transported by ambulance and definitely not by an 85 year old with his own issues. This was before we discovered the Alzheimer's. The bill for her home care would have been about $200K per year. They would have been indigent in slightly over a year.

Only the most minor in home assistance can compete financially with an assisted living or nursing facility.

The second issue is social interaction. At the various facilities they work vary hard to create activities for the residents that are tailored to their abilities. Stay at home and the family will be the only visitors and the TV the only activity. They will become even more isolated if they are staying in their home alone.

I've seen and heard of many elderly people get hostile and violent about the prospect of moving out of their house. They seem perfectly happy to have family members restructure their lives to meet their goal for many years. I personally think that that's a sign of mental deterioration.
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 04:23 PM   #33
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Re: Entrance Fees: Continuing Care Community

I agree with you, Brat and 2B. Too bad mother doesn't She arranged for in-home care for her parents and husband, mostly at her own expense, and expects her children to do the same for her. The difference being that when her parents declined, she was in her peak earning years with a pension to look forward to and felt she could spend freely (she was never a saver--always lived at her means), and when my father declined enough to need help with daily living, he was mere weeks from death. Even so, she put my grandparents in a nursing home eventually (she likes to forget that inconvenient fact). But my older brother and I are already retired, and my younger brother's in the last few years of pushing to save as much as possible before retiring (my having read him the riot act scared the bejeesus out of him by showing what he'd have to live on at the rate he was going!). Anyhow, if Mom needs many months of round-the-clock in-home care, it will have to be in a facility--she just doesn't know it yet, and neither does my brother with the purse strings.

Anyhow, one bridge to cross at a time...her driving has started to deteriorate. I have offered to take her anywhere at any time, but unless we're both going (like to Costco or out to eat), she won't avail herself of my offer. sigh. At least she stopped driving at night on her own, and by moving next door to me she's closer to the places she goes regularly (hair dresser, Barnes & Noble, lunch spots, bridge games). She's so strong-willed already...it could get ugly.
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 04:53 PM   #34
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Re: Entrance Fees: Continuing Care Community

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She's so strong-willed already...it could get ugly.
Yup. Your mom sounds like mine. Insisted on staying in her own (three storey) house as long as possible. After a hospital admission, we managed to get her into a wonderful convalescent center and then into their independent living facility. After a few weeks she felt bored and insisted on going home, where she managed with home care for almost a year before health issues caught up with her again. Under no circumstances would she allow the house to be sold. It was her way or the highway.

It was a very difficult couple of years......at least I do not feel guilty. I did everything possible to support her, sometimes against my better judgment.
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 04:58 PM   #35
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Re: Entrance Fees: Continuing Care Community

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Yup. Your mom sounds like mine. Insisted on staying in her own (three storey) house as long as possible. After a hospital admission, we managed to get her into a wonderful convalescent center and then into their independent living facility. After a few weeks she felt bored and insisted on going home, where she managed with home care for almost a year before health issues caught up with her again. Under no circumstances would she allow the house to be sold.

It was a very difficult couple of years......
That's where a POA and some backbone are necessary. My FIL would hop in his car and drive home (or at least try) if we'd give him the keys. He'd put my MIL in on the passenger side and take her too.

My DW is finally getting it all together and we'll sell the car at Car Max next weekend. Their house is going to be listed by the end of the month. If we asked either my MIL or FIL they'd go ballistic. The car and house need to be sold. They will never use either of them again and they need the money for their care.


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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 05:09 PM   #36
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Re: Entrance Fees: Continuing Care Community

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Originally Posted by astromeria
She arranged for in-home care for her parents and husband, mostly at her own expense, and expects her children to do the same for her. Anyhow, if Mom needs many months of round-the-clock in-home care, it will have to be in a facility--she just doesn't know it yet, and neither does my brother with the purse strings.

Anyhow, one bridge to cross at a time...her driving has started to deteriorate. She's so strong-willed already...it could get ugly.
The longer you let it go the uglier it will get.* She will continue to make her plans and the longer it goes the more it will be cemented in her mind.

You've got all of the POAs necessary but she has split the responsibilites.* In reality, any one of you can screw up any attempt to do what the other two decide to do.

There is a fine line between "competence" and "incompetence" and the level required is probably spelled out in the POAs.* Fortunately, my in-laws only required a single doctors letter saying that they were not able to manage their own affairs -- very broad and easy to obtain.* If your mother has a doctor concerned about her mental state, you may have an easy out.

She may "expect" her loving children to cough up the cash so she can stay at home but there's isn't a law requiring it.* The brother with financial control (if/when the POAs are triggered) needs to know where people are at.* He may not be real happy with the prospect of funding this himself.* What sane parent would want their children to impoverish themselves for their goal of staying in their house?

If your mother continues on her path, take her to a neurologist.* You'll at least get a letter saying she shouldn't drive (take the keys) and possibly get a better idea about whether she's gone off the deep end.*
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 05:24 PM   #37
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Re: Entrance Fees: Continuing Care Community

Quote:
Originally Posted by astromeria
... if Mom needs many months of round-the-clock in-home care, it will have to be in a facility--she just doesn't know it yet, and neither does my brother with the purse strings.

Anyhow, one bridge to cross at a time...

.. and by moving next door to me she's closer to the places she goes regularly (hair dresser, Barnes & Noble, lunch spots, bridge games). She's so strong-willed already...it could get ugly.
Under your circumstances I would not have this discussion with your mother until the time comes. *Maybe she will decline quickly and it won't be an issue. However, since she lives next door we know who will have the responsibility of looking after her. * *

When that day arrives you will need to sit down with brother and get real about her financial resources and your ability to manage her care and entertainment for an extended period.* This is backbone time, big time.

In some societies Mom moves in with the kids. *In many ways that is smarter for home care (easier to keep an eye on care givers). *If that is on the table tell brother that she will move in 6 months to his house* .* That is what happened to one of my great-grandmothers when she needed care.* It wasn't long before a daughter-in-law held a family meeting, she was moved to "a home".

I agree, a POA will help manage her resources once she is frail. *Not just to sell the house if need be, but to make other necessary financial decisions as they come up.
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Re: Entrance Fees: Continuing Care Community
Old 09-17-2006, 06:38 PM   #38
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Re: Entrance Fees: Continuing Care Community

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Originally Posted by Brat
Under your circumstances I would not have this discussion with your mother until the time comes. *

I agree, a POA will help manage her resources once she is frail. *Not just to sell the house if need be, but to make other necessary financial decisions as they come up.
My experience with "old people" is that it is seldom, if ever, worth having a discussion with them. The know that walkers are for "old people" so they won't use them. They also know they are going to stay in their home. Old people homes are for "old people" so they aren't "old enough" to go there.

Also, the bulk of the assets of most "old people" is in their homes. If you sit on it when you are worrying "Mom" won't like selling, you are going to run out of cash really fast.
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